GRADUATE PROGRAMSCalifornia State University, Bakersfield
California State University, Chico
California State University, Dominguez Hills
California State Univeristy, East Bay
California State University, Fresno
California State University, Fullerton
California State University, Long Beach (and distance education sites CSU, Channel Islands and CSU, Sonoma)
California State University, Los Angeles
California State Univeristy, Northridge
California State University, San Bernardino
California State University, Stanislaus
Humboldt State University
Loma Linda University
Sacramento State University
San Diego State University
San Francisco State University
San Jose State University
University of California, Berkeley
University of California, Los Angeles
University of Southern California

UNDERGRADUATE PROGRAMS
Azusa Pacific University
California State University, Chico
California State University, Fresno
California State University, Long Beach
California State University, Los Angeles
California State University, Sacramento
Humboldt State University
La Sierra University
Pacific Union College
San Diego State University
San Francisco State University
San Jose State University
Whittier College

COUNTY PUBLIC CHILD WELFARE AGENCIESAlameda County Social Services Agency
Alpine County Health and Human Services Agency
Amador County Health and Human Services Agency
Butte County Department of Employment and Social Services
Calaveras County Calaveras Works and Human Services Agency
Colusa County Department of Health and Human Services
Contra Costa County Employement and Human Services Department
Del Norte County Department of Health and Social Services
El Dorado County Department of Social Services
Fresno County Human Services System
Glenn County Human Resource Agency
Humboldt County Social Services Branch
Imperial County Department of Social ServicesInyo County Department of Health and Human Services
Kern County Department of Human Services
Kings County Human Service Agency
Lake County Department of Social Services
Lassen County Social and Community Services
Los Angeles County Department of Public Social Services
Los Angeles County Department of Children and Family Services
Madera County Department of Social Services
Marin County Health and Human Services Department
Mariposa County Human Services Department
Mendocino County Department of Social Services
Merced County Human Services Agency
Modoc County Department of Social Services
Mono County Department of Social Services
Monterey County Department of Social Services
Napa County Health and Human Services Agency
Nevada County Human Services Agency
Orange County Social Services Agency
Placer County Health and Human Services Administration
Plumas County Department of Social Services and Public Guardian
Riverside County Department of Public Social Services
Sacramento County Department of Human Assistance
Sacramento County Department of Health and Human Services
San Benito County Health and Human Services Agency
San Bernardino County Human Services System Administration
San Diego County Health and Human Services Agency
San Francisco County Department of Human ServicesSan Joaquin County Human Services Agency
San Luis Obispo County Social Services Department
San Mateo County Human Services Agency
Santa Barbara County Social Services Department
Santa Clara County Social Services Agency
Santa Cruz County Human Resource Agency
Shasta County Department of Social Services
Sierra County Department of Human Services
Siskiyou County Human Services Department
Solano County Health and Social Services Department
Sonoma County Human Services Department
Stanislaus County Community Services Agency
Sutter County Welfare and Social Services Division
Tehama County Department of Social Services
Trinity County Health and Human Services Department
Tulare County Health and Human Services Agency
Tuolumne County Human Services Agency
Ventura County Human Services Agency
Yolo County Department of Employment and Social Services
Yuba County Health and Human Services Department

REGIONAL TRAINING ACADEMIESCenter for Human Services Training and Development (UC, Davis)
Academy for Professional Excellence (San Diego State University)
Central California Public Social Services Training Academy (CSU, Fresno)Bay Area Training Academy (San Francisco State University)
Center for Child and Family Policy Studies (UCLA)

Complete the form below then print and sign.
Fax or mail the form to the phone number/address provided.

California Child Welfare Resource Library

Agency Borrower Authorization Form

We, the undersigned, agree to abide by the rules and regulations of the California Child Welfare Resource Library outlined in the CHECKOUT POLICIES AND PROCEDURES, which we have reviewed and retained for reference.

We request that a borrowing account be opened in the name of the Agency named below, with the Field Instructor named below as the active borrower.

The Agency further accepts responsibility for any fines or fees which accrue through use of the Library by the Field Instructor named below if the Library is unable to collect said fines or fees from the Field Instructor.

This agreement expires on June 30, 2013, or when the Field Instructor named below terminates Field Instructor status of a Title IV-E student, whichever comes first.

Agency Name:

Agency Director:

Agency Director Signature:

Agency Address:

Agency Telephone #:

Field Instructor:

Field Instructor Signature:

Field Instructor Telephone #:

Field Instructor Email:

Return by fax or mail to:

Cheryl Fujii
Resource Specialist
School of Social Work
California State University, Long Beach
1250 Bellflower Boulevard
Long Beach, CA 90840-4602